Treatment approaches for spondylolisthesis vary based on the type and grade of slippage, presence of neurological symptoms, patient age, overall health status, and functional limitations. The primary goals are to relieve pain, stabilize the spine, prevent progression of slippage, and restore function. Treatment options typically include:

Conservative Management:

• Activity modification and rest during acute pain episodes

• Physical therapy focusing on:

  • Core strengthening to improve spinal stability

  • Hamstring stretching to reduce strain on the lumbar spine

  • Specific exercises to improve posture and body mechanics

  • Pain-relieving modalities such as heat, ice, or electrical stimulation

• Medication management:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation

  • Muscle relaxants for associated muscle spasms

  • Limited use of opioids for severe, acute pain episodes

• Bracing or lumbar supports:

  • May be useful in younger patients with active pars defects

  • Can provide temporary relief during symptomatic periods

  • Generally not recommended for long-term use as it may lead to muscle deconditioning

• Weight management to reduce stress on the spine

• Modification of activities that exacerbate symptoms, particularly those involving hyperextension

Interventional Procedures:

• Epidural steroid injections for radicular symptoms

• Facet joint injections or medial branch blocks for facet-mediated pain

• Intradiscal therapies for associated disc degeneration

• Pars interarticularis injections for active pars defects

• Radiofrequency ablation for facet-related pain

Surgical Management: Surgery is typically considered when conservative measures fail to provide adequate relief, neurological symptoms are progressive, slippage is high-grade or advancing, or quality of life is significantly impacted. Surgical options include:

• Decompression procedures:

  • Used when neurological symptoms are the primary concern

  • May include laminectomy, foraminotomy, or microdiscectomy

  • Often combined with fusion in cases of instability

• Spinal fusion:

  • Stabilizes the affected segment by eliminating motion between vertebrae

  • May be performed using various approaches (posterior, anterior, or combined)

  • Can utilize different fixation methods including pedicle screws, rods, and interbody devices

  • Often supplemented with bone graft to promote solid fusion

• Direct repair of pars defects:

  • Option for young patients with isthmic spondylolisthesis without significant slippage

  • Preserves motion at the affected level

  • Techniques include pars screw fixation or hook-rod constructs

• Reduction of slippage:

  • May be attempted in severe cases, particularly in children and adolescents

  • Controversial in adults due to increased neurological risk

  • Usually combined with fusion procedures

Special Considerations:

• Children and Adolescents: Require close monitoring for progression during growth spurts; may need more aggressive intervention if slippage increases

• Athletes: May need sport-specific rehabilitation and possibly activity modification to return safely to competition

• Elderly Patients: Treatment often focuses on symptom management and maintaining function rather than correcting deformity

• Pregnant Women: May experience temporary worsening of symptoms; typically managed conservatively with physical therapy and support garments

The prognosis for spondylolisthesis varies widely. Many patients with low-grade slippage achieve satisfactory results with non-operative treatment, while those requiring surgery generally experience significant improvement in pain and function, though complete resolution of all symptoms is not always achieved.

Long-term monitoring is recommended, particularly in younger patients and those with higher-grade slippage, to detect any progression that might require intervention.